Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are value-based insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence.

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